Federico Garola

Background: The expanding use of glucagon‐like peptide‐1 receptor agonists and the dual incretin agonist tirzepatide for Type 2 diabetes mellitus and obesity has drawn attention to potential oral and salivary adverse effects. This short communication summarizes the available evidence, discusses potential mechanisms, and highlights implications for oral medicine practice. Methods: A narrative synthesis of published case reports, pharmacovigilance findings, and indirect experimental evidence was undertaken to discuss reported manifestations, biological plausibility, and existing knowledge gaps. Results: Reported manifestations include xerostomia, hyposalivation, dysgeusia, oral mucosal discomfort, burning sensations, and throat‐related symptoms. Proposed mechanisms include modulation of cyclic adenosine monophosphate‐dependent signaling in salivary acinar cells, altered autonomic regulation of salivary secretion, and dehydration secondary to gastrointestinal adverse events. Reduced salivary protection combined with gastric acid exposure from reflux or vomiting may increase susceptibility to dental erosion, although a direct association with these therapies has not been established. Sporadic immune‐mediated mucocutaneous reactions and facial soft‐tissue changes associated with rapid weight loss have also been described. Evidence remains limited and largely indirect. Conclusion: Potential oral and salivary adverse effects warrant clinical awareness, careful medication history‐taking, assessment of salivary function, and individualized preventive care. Systematic reporting and focused clinical and experimental studies are needed to clarify causality, frequency, and underlying mechanisms.

Objective: Epidemiological and survival data on osteosarcoma of the jaws (OSJ) in Latin America remain scarce. We characterized the clinicopathological, radiographic, treatment‐related, and survival features of OSJ in Latin America. Methods: This multicenter case series involved 22 institutions from Brazil, Chile, Argentina, Colombia, Venezuela, Uruguay, and Mexico. Demographic, clinical, radiographic, histopathological, treatment, and survival data were analyzed using descriptive and inferential statistical methods. Survival outcomes were assessed using Kaplan–Meier analysis and Cox regression models. Results: A total of 119 OSJ cases were included. The median age was 33 years, with a female predominance (58%), and the mandible was the most commonly affected site (68.9%). A mixed radiographic appearance predominated and was frequently accompanied by cortical perforation and a sunburst periosteal reaction. Histologically, the osteoblastic subtype accounted for 63.5% of cases. Surgical resection was the main treatment modality (71.2%). Increasing age ( p = 0.034) and multimodal or nonsurgical management ( p = 0.023) were independently associated with poorer survival. The estimated overall survival rates were 67.5% at 12 months and 37.5% at 60 months. Conclusion: Data corroborate previous literature and demonstrate that OSJ in Latin America predominantly affects adults and exhibits aggressive patterns. Surgical management remains central to improving survival whenever it is technically feasible.

Objective: This study assessed the frequency and clinical features of MRONJ with exclusive palatal involvement at two Oral Medicine referral centers. Methods: A retrospective cross-sectional study included consecutive patients diagnosed with MRONJ between 2016 and 2025 at two referral centers in Córdoba, Argentina. Clinical records, imaging studies, and histopathological reports were reviewed. The frequency of exclusive palatal involvement was determined, and demographic, clinical, radiographic, and histopathological characteristics were analyzed descriptively. Results: Among 58 patients with MRONJ, 5 (8.6%) presented exclusive palatal involvement without concomitant maxillary or mandibular lesions. All patients were women (mean age, 78.4 years) receiving oral antiresorptive therapy for osteoporosis. Clinical findings ranged from mucosal breakdown to exposed necrotic bone with fistulization. Contributing local factors included prosthetic irritation and palatal exostoses. Imaging findings were often subtle or non-specific, whereas histopathological examination confirmed osteonecrosis when performed. Conclusion: Exclusive palatal MRONJ is an uncommon but clinically significant presentation. Awareness of this atypical location may facilitate earlier diagnosis and improve management in patients receiving antiresorptive therapy.

This study examines how local chronic inflammatory conditions, particularly oral dysbiosis, Candida-associated inflammation, and chronic mechanical irritation, may modify the clinical and histopathological presentation of oral potentially malignant disorders (OPMDs) and complicate their assessment in routine practice. This expert clinical perspective, supported by selected literature and representative clinical scenarios, addresses clinicopathological gray zones arising when OPMDs coexist with inflammatory and microbial disturbances. These conditions may accentuate erythema, ulceration, hyperkeratosis, epithelial hyperplasia, and reactive cytological atypia, potentially complicating the distinction between inflammation-associated changes and true oral epithelial dysplasia (OED). Oral dysbiosis and Candida-associated inflammation may further modify the local inflammatory microenvironment and lesion phenotype. Recognition of these modifiers may inform biopsy timing and site selection, histopathological interpretation, and communication between clinicians and pathologists. Local inflammatory and microbial modifiers should be considered when evaluating OPMDs, particularly when clinical and histopathological findings are equivocal or discordant. Careful clinicopathological correlation and further prospective studies are needed to clarify the interactions among oral dysbiosis, chronic inflammation, and epithelial alterations in OPMDs.

Introduction: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect multiple organs, including the oral mucosa. Although SLE has been recognized as an oral potentially malignant disorder (OPMD), malignant transformation within lupus-related oral lesions is exceptionally rare. Case report: This report describes a 77-year-old woman with SLE who developed three synchronous oral carcinomas — two verrucous carcinomas and one conventional oral squamous cell carcinoma (OSCC) — after years of chronic, treatment-refractory mucosal lesions. Histopathological examination revealed multifocal epithelial dysplasia and carcinoma, suggesting a phenomenon of field cancerization (FC). The patient, who lacked classical risk factors such as tobacco or alcohol use, was treated successfully with radiotherapy, achieving complete remission and no recurrence after 18 months of follow-up. The present report highlights the potential role of chronic inflammation and long-term immunosuppression in oral carcinogenesis in SLE. It also underscores the diagnostic challenges in differentiating lupus lesions from other OPMDs and the importance of serial biopsies for early detection of dysplastic transformation. Conclusion: The coexistence of FC and SLE has not been previously reported, and this case contributes novel clinical and histopathological evidence supporting the inclusion of SLE among conditions predisposing to multifocal oral cancer.

Objective(s): To present a novel approach using subspinal osteotomy for the extraction of mesiodens, addressing limitations of traditional surgical techniques. Study Design: A technical note detailing the subspinal osteotomy procedure, emphasizing its minimally invasive nature and preservation of perinasal structures. Results: The technique allows for effective extraction of deeply impacted mesiodens with minimal dissection, reducing risks to adjacent anatomical structures. Clinical outcomes demonstrate preservation of the anterior nasal spine (ANS) position and muscle insertions, promoting faster recovery and less postoperative discomfort. Conclusion(s): Subspinal osteotomy is a safe, cost-effective, and minimally invasive alternative for mesiodens extraction, suitable for both local and general anesthesia. Its implementation in routine clinical practice is recommended to enhance surgical outcomes and patient satisfaction.

La armonización orofacial se ha consolidado como una disciplina en expansión dentro de la odontología y la medicina estética, impulsada por el uso creciente de materiales de relleno dérmico. Si bien estos procedimientos se consideran mínimamente invasivos, su aumento exponencial ha sido acompañado por un incremento en la frecuencia de efectos adversos (EA), los cuales pueden comprometer tejidos blandos, estructuras vasculonerviosas y la mucosa oral. Se presenta una serie de tres casos clínicos de EA asociados al uso de fillers en la región orofacial. Dos de los casos corresponden a siliconomas labiales, con correlación clínica, ecográfica Doppler e histopatológica, manifestados como nódulos submucosos firmes de aparición tardía. El tercer caso describe una complicación neurosensorial, caracterizada por disestesia perilabial, asociada a la aplicación previa de hidroxiapatita de calcio (Radiesse®), sin lesiones clínicas visibles, cuyo diagnóstico se sustentó en la tomografía computarizada. Los casos ilustran la heterogeneidad clínica y fisiopatológica de los EA por fillers, así como la importancia de una anamnesis dirigida, el examen estomatológico exhaustivo y el uso racional de métodos complementarios de diagnóstico por imágenes. La estomatología desempeña un rol central en el reconocimiento temprano, el diagnóstico diferencial y el abordaje interdisciplinario de estas complicaciones.